HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
0
o 2300 VIRGINIA AVE
- FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 15 r '- ADDRESS:
i, SS(7w Q ,am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
OWNtI R CON CTOR SIGNATURE DATE
,J,fr,
Prin ame
STATE OF FLORIDA
COUNTY OF
ACKN EDGED BEFORE ME THISDAY OF 204
BY J4i7tX4AO- I P ONALLY KNOWN TO ME OR
HAS VIDED C/r— - ) i t. AS IDENTIFICATION.
STATE OF FLORIDA,County of
WA—
SIGNATURE OF NOYRY SEAL
-------------------------------------------------------------------- - - - - - -----------------------------------------
FOR OFFICE USE ONLY: < �P� �; AUDREY B.HUMPHREY
MY COMMISSION#GG 300817
Number of Open Inspections: ^,,. �;g= EXPIRES:March 6,2023
;oF Ft°' Bonded Thru Nota Underwriters
Total Inspections: Notary Public Unde
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014